Hood’s AchillesBlog

I had my next appointment on July 2, 33 days after my surgery. I was told at my previous appointment that I would have the cast off that day and start with the heel wedges in my shoes. I was a little confused, as everything I was reading in ortho books and on Achillesblog was saying that usually people were in CAM walkers for many more weeks. However, my excitement to ditch the cast for good really blinded me here. I was the happiest guy in the world when I walked into my appointment that day. I hated that cast more than anything in the world. I had the cast taken off, and waited for my surgeon to see me. Here’s further calf atrophy (on the right, in case you couldn’t figure that out).

My surgeon came in, felt the tendon, said it felt good, and said 3 more weeks in the cast. I was absolutely crushed. Apparently there was some miscommunication on both ends at the last appointment. I told him that in 3 weeks, I wouldn’t be in town, as I was moving to start fellowship in Houston. He said, ok, 2 weeks is fine. I asked if he did CAM walkers, as I would be happy to wear one of those indefinitely, as long as I could shower and sleep like a normal person. But no, he doesn’t do those, so I was stuck in the cast. Those 2 weeks crawled by, but I had a countdown on my phone and busied myself studying for boards. Finally July 16th came, and again, I was the happiest guy in the word. This time the cast came off and stayed off. My surgeon gave me small gel wedges to put in both my shoes and gave me very vague instructions about what to do. But he made it seem like I was free to walk around normally with the wedges. He also wanted me to start PT. Here’s my calf at it’s puniest.

I wanted to jump for joy, but I obviously didn’t. I gingerly walked around the office and then to my car. I couldn’t believe that I was walking again without a large apparatus on my foot. It really felt great. I was on top of the world.

So I forgot to mention that the day after my surgery, about 24 hours after my saphenous block was placed, I started to have some pain at the incision site. I had some norcos that my surgeon gave me, and they took care of the pain pretty well. I was also taking ibuprofen. The norcos worked, but they made me just sleepy as hell, so I wasn’t too excited about taking them for long. I only took about 10 in total before I couldn’t handle being a zombie anymore. At about 5 days postop, I wasn’t taking anything for pain. The struggle was more mental - getting used to hobbling around and living without the use of a leg. I have so much more respect for disabled/injured people. We take so much for granted on a day-to-day basis.

I got around ok on my knee-scooter, only using crutches when I absolutely had to. I wasn’t sleeping well - my cast was so hot, and I felt sweaty all the time. Pretty miserable. I went back to work on POD 12, and coincidentally had another appointment with my surgeon that day as well. Here’s my incision that day, and then my legs after only 12 days in a cast. Injured leg on the right. My calves have always been pretty big, so the difference is really obvious here.

At this point they put me in a new cast, with a toe plate, and a slight "build" on the heel, that allowed me to partially weight bear. When the cast tech finished, and told me to take a step, I was super nervous. But I was assured by the surgeon and all my orthopod friends that since I was in a cast, it was virtually impossible for me to injure my tendon. Here’s the new cast, with the sweet boot they gave me.

I lasted 4 days with this cast before I couldn’t handle it anymore. The toe plate allowed no air to circulate and I felt like I was in a wet sock. On POD 16, I went into my surgeon’s clinic to get a new cast put on, without the toe plate. I still had the build on and was partially weight-bearing. I hated the cast, but being able to put a little weight on it was much better than the one-legged routine. Here’s further atrophy at POD 16.

I don’t have a picture of the 3rd cast, but I will offer this piece of advice: if you have the chance, opt for no toe plate. I couldn’t stand it.

So first, I would like to thank Dennis at Achillesblog and all the other posters out there for helping me through all of this. You guys have been invaluable as a resource and as a support group. Thank you.

So today, I’m 9 weeks postop. I’ll give you a short play-by-play. Tore my Achilles playing soccer on 5/29/12. Just lunged for the ball, heard the characteristic pop/thunk, and knew right away. Definitely didn’t stretch out. Oh, to go back to that day… I was sort of in a unique position, as I was an anesthesiology resident at the time. I called my orthopedic friends, and they saw me right away in the ER. The nurses were all very nice and I got splinted up and out of there in about 3 hours, which is fast for our ER.

Went to work the next day (5/30), and it just so happened that I was in an OR with a sports orthopod. I hadn’t had breakfast (very fortuitous), and the surgeon said if I wanted, he could do the surgery at the end of the day. Again, I had the unique position here, and was lucky. I chose spinal anesthesia with a sciatic catheter for post-op pain control. I didn’t have any sedation at all, as I didn’t want to say anything stupid in front of people I worked with, but I would whole-heartedly recommend it for anyone else getting a catheter. The needle we use to place the catheter is quite large and despite the local anesthetic numbing, you feel it. Anyways, the block and the spinal went fine, and I listened to music and surfed the internet on my iPad during my surgery. Before the spinal wore off, my anesthesia team also performed a saphenous block. I think this was the biggest factor in my post-op pain control. I went home that night with a completely numb foot in a splint with instructions to follow up in 2 days to switch the splint for a cast.

Came in that day and had the cast put on. Here’s the wound, 2 days post-op.

Had a sweet neon green cast put on that I classed up with some blue paint to match the wedding colors of my good friend whose wedding I was attending the next weekend.

I actually had the next week off from work, which was very, very nice. I would have liked to spend the vacation not sitting on my couch, but oh well. I lasted about 2 days on the crutches before I asked some people around the hospital about a knee scooter. I was connected with a medicine physician who had bought his because he had a prolonged, complicated course. He sold me it for $100, and it paid for itself within a week. It is far, far superior to crutches. If you’re concerned about the cost, I can guarantee you it’s worth it. Ok, I’ll cut this post off for now and start another with my next couple weeks.